Kuvunika amaguru ni bumwe mu bwoko bukunze kuvunika mubikorwa byubuvuzi. Usibye ibikomere bimwe byo mu cyiciro cya I / II no gukomeretsa abantu, kuvunika amaguru akenshi birimo malleolus kuruhande. Ubwoko bwa Weber A / B bwavunitse bwa malleolus busanzwe butera syndesmose ya tibiofibular ya kure kandi irashobora kugabanuka neza hamwe no kubona neza kuva kure kugeza hafi. Ibinyuranye, kuvunika kwa C ubwoko bwa malleolus burimo guhungabana muri malleolus kuruhande rwamashoka atatu kubera imvune ya tibiofibular ya kure, ishobora gutera ubwoko butandatu bwo kwimurwa: kugabanya / kurambura, kwaguka / kugabanya umwanya wa tibiofibula intera, kwimura imbere / inyuma mu ndege ya sagittal, hagati / kuruhande ihengamye mu ndege ya coronale, gusimburana kuzunguruka, hamwe no guhuza ubu bwoko butanu bwimvune.
Ubushakashatsi bwinshi bwibanze bwerekanye ko kugabanya / kurambura bishobora gusuzumwa hifashishijwe gusuzuma ikimenyetso cya Dime, umurongo wa Stenton, hamwe na tibial-gapping angle, nibindi. Gusimburwa mu ndege ya coronale na sagittal birashobora gusuzumwa neza ukoresheje fluoroscopique imbere; icyakora, guhinduranya kwimuka nicyo kigoye cyane gusuzuma muburyo budasanzwe.
Ingorane zo gusuzuma iyimurwa ryizunguruka zigaragara cyane cyane mukugabanuka kwa fibula mugihe winjizamo tibiofibular ya kure. Ubuvanganzo bwinshi bwerekana ko nyuma yo gushyiramo umugozi wa tibiofibular ya kure, habaho 25% -50% yo kugabanuka nabi, bikaviramo malunion no gukosora ubumuga bwa fibular. Bamwe mu bahanga batanze igitekerezo cyo gukoresha isuzuma rya CT risanzwe, ariko ibi birashobora kugorana kubishyira mubikorwa. Kugira ngo iki kibazo gikemuke, mu mwaka wa 2019, itsinda rya Porofeseri Zhang Shimin wo mu bitaro bya Yangpu rishamikiye kuri kaminuza ya Tongji ryasohoye inyandiko mu kinyamakuru mpuzamahanga cy’amagufwa * Injury *, risaba uburyo bwo gusuzuma niba kuzenguruka kwa malleolus byakosowe hakoreshejwe X-ray. Ubuvanganzo buvuga imikorere ikomeye yubuvuzi.
Ishingiro ryuburyo bwubu buryo nuko muburyo bwa fluoroscopique yibirenge, urukuta rwuruhande rwuruzitiro rwa malleolar fossa yerekana igicucu gisobanutse neza, gihagaritse, cyijimye, gihwanye na cortice yo hagati na malleolus, kandi iherereye kuri hagati kugeza hanze kimwe cya gatatu cyumurongo uhuza cortices yo hagati na kuruhande rwa malleolus.
Igishushanyo cyerekana amaguru ya fluoroscopique yerekana isano iri hagati yurukuta rwuruhande rwuruzitiro rwa malleolar fossa (b-umurongo) hamwe na cortices yo hagati na kuruhande rwa malleolus (umurongo wa c na c). Mubisanzwe, b-umurongo uherereye kumurongo winyuma wa gatatu hagati yumurongo a na c.
Umwanya usanzwe wa malleolus kuruhande, kuzunguruka hanze, no kuzenguruka imbere birashobora kubyara amashusho atandukanye muburyo bwa fluoroscopique:
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-Uburyo bwa malleolus yo kuzenguruka hanze **: Kuruhande rwa malleolus kuruhande rusa nk "amababi atyaye," igicucu cya cortical on malleolar fossa irazimira, umwanya wa tibiofibular intera uragabanuka, umurongo wa Shenton uhinduka kandi ugatatana.
-Ibice bya malleolus byimbere byimbere **: Ibice bya malleolus kuruhande bigaragara "ishusho yikiyiko," igicucu cya cortical kuri fossa ya malleolar fossa irazimira, kandi umwanya wa tibiofibular uri kure waguka.
Iri tsinda ryarimo abarwayi 56 bafite imvune zo mu bwoko bwa C zo mu bwoko bwa malleolar zifatanije n’imvune ya tibiofibular ya syndesmose ya kure kandi bakoresheje uburyo bwo gusuzuma bwavuzwe haruguru. Nyuma yo kwisuzumisha CT nyuma y’ubushakashatsi bwerekanye ko abarwayi 44 bageze ku kugabanuka kwa anatomike nta guhindagurika kwabo, mu gihe abarwayi 12 bahuye n’ubumuga bworoheje (munsi ya 5 °), bafite ibibazo 7 byo kuzenguruka imbere n’abandi 5 bazunguruka hanze. Nta bihe byo kugereranya (5-10 °) cyangwa bikabije (birenze 10 °) ubumuga bwo kuzenguruka hanze bwabayeho.
Ubushakashatsi bwibanze bwerekanye ko isuzuma ryo kugabanya kuvunika kwa malleolar kuruhande rushobora gushingira ku bipimo bitatu byingenzi bya Weber: uburinganire buringaniye hagati ya tibial na talar ihuriweho, gukomeza umurongo wa Shenton, n’ikimenyetso cya Dime.
Kugabanuka nabi kwa malleolus kuruhande nikibazo gikunze kugaragara mubikorwa byubuvuzi. Mugihe hitabwa cyane kugarura uburebure, akamaro kangana kagomba gushyirwa mugukosora kuzunguruka. Nkibintu bifata uburemere, malreduction yose yibirenge irashobora kugira ingaruka mbi kumikorere yayo. Byizerwa ko tekinike yo mu bwoko bwa fluoroscopique yatanzwe na Porofeseri Zhang Shimin ishobora gufasha mu kugabanya neza kugabanuka kwa C yo mu bwoko bwa malleolar. Ubu buhanga bukoreshwa nkibikoresho byingenzi kubaganga bambere.
Igihe cyo kohereza: Gicurasi-06-2024
